I will be under Aetna this coming fall, which has a provision for GRS in their policy, IF my specific carrier has it. My carrier will be Chickering, but I can't find out if they are one of the ones that covers GRS . I can't find out from the website because I don't have an account yet and can't login. I know Aetna (or at least Chickering specifically) doesn't have a penalty period or anything like that for pre-existing conditions, but still, I have reservations about just calling them and asking. I don't want to mess anything up just because I'm not actually covered by Aetna *yet*.

I would hope Chickering is one of the more liberal carriers (that would allow for GRS coverage) because it's supplied by my university. Does anyone here know if this carrier has the GRS coverage provision?

Also, I've been researching surgeons and so far my favorite seems to be Menard/Brassard. Does anyone know, or have experience with US health insurance in Canada? I'm really hopefully that I might be able to get insurance to at least partially cover it (if not fully). My doctor/therapist has actually had success through a lawyer she knows personally, getting insurance to cover other patients' surgeries. BUT, it won't matter if I can't get the coverage in Montreal to begin with.

Any comments would be adored.

I had to get legal with my insurance carrier. They told me flat out that they would not cover it.  Fortunately, I had the aid of Sister Mary Elizabeth and she had listings of all the court cases at the time and she passed that material on to me. I crafted a 10 page document.  The insurance folks told me that since "I" was so tenacious to write something like that, they could not imagine what my lawyer would do!  So they caved in and paid 70 percent.

I'm sorry but I don't have any current info on insurance.  I had my SRS 19 years ago.

Cindi

I wish I knew since I have Aetna as well.

This should be in your benefits guide under "exclusions" ask your employer for the guide.  Generally speaking though you HAVE to remain stateside if it is covered (the most common exclusion is for proceedures performed outside of the United States).

Cindi -- I'm hoping that if my carrier doesn't have it I could scare them with a lawyer and have a similar result. That's amazing for 19 years ago!

Amy -- Grrrrahhhaaah! [insert continued unsettled sounds] I was expecting something like that. I really have my heart set on Montreal! Will try not be disappointed until I find out for certain. Will figure something out (even if it involves me taking out a personal loan to get the surgeon I want ). Besides, Brassard is actually the closest to me.

Melissa -- But you're going overseas so it's not an optimistic situation anyway (as per Amy's post). So happy for you by the way! I might not post a lot here at Susan's, but I do read a lot. We've both had similarly matching timelines on this journey, and I remember where we both were 2 or 3 years ago (or maybe more or less). Anyway, you have my well wishes.

Quote from: Elaine on May 09, 2007, 09:31:12 PM
Cindi -- I'm hoping that if my carrier doesn't have it I could scare them with a lawyer and have a similar result. That's amazing for 19 years ago!

Amy -- Grrrrahhhaaah! [insert continued unsettled sounds] I was expecting something like that. I really have my heart set on Montreal! Will try not be disappointed until I find out for certain. Will figure something out (even if it involves me taking out a personal loan to get the surgeon I want ). Besides, Brassard is actually the closest to me.

Melissa -- But you're going overseas so it's not an optimistic situation anyway (as per Amy's post). So happy for you by the way! I might not post a lot here at Susan's, but I do read a lot. We've both had similarly matching timelines on this journey, and I remember where we both were 2 or 3 years ago (or maybe more or less). Anyway, you have my well wishes.

There is somewhat of a possibility that they would cover a procedure in Canada, but any procedure in Thailand is out of the question.  Brassard is a US licensed doctor, so there is more of a possibility that you may argue for coverage.  It is still worth checking out if you have the exclusion or not in the policy, or the transgender rider was present.  Even if there is the exclusion, you can fight it if you live in one of the states with a transgender non-discrimination law or one of the states with good court precedent.  You may still get them to cover at least part of the costs as long as you do stay stateside. 

Sorry Melissa, if I knew you had Aetna, I would have advised for you to check into your policy.  You could have actually saved money by staying stateside if the exclusion was not there.    No matter what you are incurring the full cost. 

I am a lawyer and there is an exclusion in my policy (I have BCBS), and I will be fighting the exclusion since DC has an expansive non-discrimination law, and since the exclusion is no longer a standard practice with regards to health insurance policies, so I do have grounds to fight the exclusion.  The sad part about this, is I would love to go to Montreal myself, and may ultimately choose to do so. But if I get my insurance company to fold under legal threats it would be worthwhile to stay stateside and have this treated like any other medical problem.  I will be fighting for pre-approval, so I would not have to worry about asking for money after things are done (where a denial of coverage is almost a guarantee).   

Am I thinking about this too early (this process is about a year and a half away for me)...probably not.  It will probably take me at least a year to craft this document where it is air tight.  In addition I need time to put in place an advocacy campaign.